Standing Up from Sitting

Abstract

Patients have difficulty in standing up from sitting in a normal way as the movement requires selective activity of the trunk and the legs simultaneously. Normally when we stand up, the extended trunk is brought forwards so far that our head is over our feet or even further. As the trunk moves forwards, the extensor muscles of the hips and knees are active, and then as our seat leaves the supporting surface the knees move forward over our feet at first. The ankles are therefore required to dorsiflex further, even though there is increased activity in the hip and knee extensors (Fig. 7.1). Both hips maintain the same degree of rotation and abduction so that the knees move neither towards nor away from one another (Fig. 7.2). The arms swing slightly forward with the momentum caused by the trunk moving forwards; only when we stand up from a low stool do we use our extended arms actively in order to bring more weight forwards (Fig. 7.3). Standing up from sitting is a very important activity for the patient because if he does so in an abnormal way, he will be reinforcing a mass movement synergy, and through constant repetition extensor spasticity in his leg will be increased as a result. If he stands up incorrectly, his first steps will also be abnormal. When practised correctly the activity is most useful for retraining selective movement of the legs and the trunk, which in turn will improve the patient’s walking pattern.